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1. STABILIZE: The Essential      Exercise For Your Back

2. Science of Back Exercises   My Internet Search For    Keyword: Back Exercises   What Do These Websites    Tell Us About Back    Exercises   Traditional Treatments For    Back Pain Fail Miserably...   The BIG Problem?    Recurrence of LBP...   The Brain Has Two Separate    Strategies For Movement-    Coordination Programming   The Brain Fails To Use    Separate Strategies After    Back Injury or Pathology   WARNING!  The Following    Treatments Fail To Reduce    Recurrence...   Can Deep Stabilizing    Muscles Be Rehabilitated?    Can Normal Programming    Strategies Be Restored?   "The New Standards" that    You NEED to Know...

3. Spinal Segmental                  Stabilization

4. Ultrasound Imaging Of      Deep Stabilizing Muscles

5. Integration of Inner &      Outer Units

6. Roman Chair Back     Exercises For Strengthening

7. Functional Exercises For      Your Back

8. Back Stiffness: Exercises     And Stretching

9. Inversion Tables For      Vertebral Distraction

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Discover the New Science of Specific Back Exercises!
by Howard A. Knudsen, PT
Doctor of Physical Therapy

 Discover the New Science of Specific Back Exercises
 to Eliminate Lower Back Pain & Prevent Recurrence

Back exercises have been used to treat lower back pain for years.  But, back
exercise research did not receive much attention from scientists before the early 1990’s.  Since then, there has been an explosion of new scientific evidence published by the experts who prescribe back exercises, physical therapists.  As more evidence accumulates and these concepts are being tested in physical therapy clinics, I have found that there is a need to summarize the current findings on the internet. 

If you are looking for back exercise information based on scientific evidence, you have come to the right place!  This website is all about eliminating lower back PAIN and avoiding SURGERY!
 

 My Internet Search For Keyword: Back Exercises

I just performed a Google search with keyword "back exercises" and I am very disappointed at what I find.  Most sites that claim to "know all the answers" seem to have the same exercises that were prescribed by doctors and physical therapists many years ago.  Basically, they only provide a historical perspective on the topic of back exercises...

Here are a few examples...

Back exercises for lower back pain from the U.S. Food and Drug Administration website. 
Back pain exercises from American Academy of Orthopedic Surgeons.
I have chronic low back pain. Is there anything I can do to relieve it?  Try these exercises...
Stretching/pain relief exercises for back pain from Spine Health.
American Academy of Family Physicians: What exercises can I do to strengthen my back?
Mayo Clinic's advise is: Exercise: A healthy way to prevent back pain.

 What Do These Websites Tell Us About
 Back Exercises For Lower Back Pain

------------- Important Fact #4 -------------
These deep stabilizing muscles (transversus abdominis and the deep fibers of multifidus) do not return to normal when the pain goes away or after returning to regular physical activity.  They also do not return to normal after performing conventional back exercises, like strengthening and stretching. 
 Abstract: Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis.
 Abstract: Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain.
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------------- Important Fact #5 -------------
Other studies demonstrate that the brain reacts to pain and pathology with altered and delayed firing patterns of the deep stabilizing muscles (transversus abdominis and multifidus).  The mechanism of preparatory spinal control provided by transversus abdominis and multifidus is impaired.  This results in decreased muscle stiffness and poor spinal segmental control.  Therefore, the ability to control a joint neutral position is diminished.
 Abstract: Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds. 
 Abstract: Experimental muscle pain changes feedforward postural responses of the trunk muscles.
 Full HTML article: The Evolution of Spinal Stability in the Physical Therapy Field
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To get a basic understanding of how we lose "preparatory spinal control" after back injury or degenerative changes, you will need to read the following section...

 The Brain Has Two Separate Strategies
 For Movement-Coordination Programming

In people with no history of back injury or pathology, the brain uses two separate movement-coordination programming strategies during daily activities.  There is a separate strategy for low loads placed upon the spine with emphasis on recruitment of the "inner unit" of back and abdominal muscles (a.k.a. local, segmental, core, or deep stabilizing muscles).  There is also a high-loading strategy that emphasizes the use of the "outer unit" (a.k.a. large, strong, superficial or global muscular system).

First, let me describe the strategy used for the inner unit.  The brain recruits these deep stabilizing muscles with a low level, slow developing, continuous, tonic contraction.  This produces stiffness between individual segments to protect the spinal column from stress and strain. 

Inner unit muscles have a "low threshold" for activation.  This means that the brain recruits inner unit muscles (earlier then outer unit muscles) when low loads are placed on the lumbar spine and pelvis.

During common daily activities which involve movements of the trunk and extremities, these "inner unit" muscles are normally activated prior to the actual movement in order to help stabilize the spine.

For the second strategy, the brain recruits the "outer unit" of back & abdominal muscles.  These large, strong, superficial muscles produce intermittent, quick-developing, phasic contractions to dynamically control the orientation and alignment of the lumbar spine and pelvis.

The inner and outer units of back & abdominal muscles are both necessary for efficient spinal stability during body movement.  It is the perfect combination for stabilization as each strategy compliments the other. 

An instant before we move or lift an arm or leg, the brain recruits the inner unit of muscles to protect the individual segments of the lumbar spine and pelvis.  Transverses abdominis automatically co-contracts with multifidus to help create a stable spine for all the superficial, movement-producing, long lever muscles of the outer unit to work off of and use as a base.

 Link to Table: Compare inner versus outer unit features and characteristics

With one strategy, the brain recruits the deep stabilizing muscles of the inner unit to provide continuous, low-load protection for individual segments.  This is our "first defense" against stress and strain, and is especially important in a joint neutral position.  With the other strategy, as loading upon the spine increases, the brain intensifies the recruitment of large, torque-producing muscles of the outer unit for dynamic control.  If the load is heavy, the brain recruits the outer unit to maximal voluntary contraction, which produces co-contraction rigidity to protect the spine.
 

 The Brain Fails To Use Separate Strategies
 After Back Injury or Pathology

The deep stabilizing muscles of the inner unit become impaired after back injury or pathology.  So, the brain adopts a simplified, motor programming strategy that emphasizes excessive recruitment of the large, strong, superficial muscular system to stabilize the spine.  The brain selects these outer unit muscles because they are easier to recruit to create torso rigidity for short-term pain control.  Unfortunately, outer unit back & abdominal muscles are not capable of providing segmental stabilization.

Separate motor programming strategies for the inner and outer units are no longer present after first-episode lower back pain.  Ultrasound imaging and EMG data taken during back exercises show that there is poor coordination and sequencing of these deep and superficial stabilizing muscle groups.  Although painful symptoms usually disappear within a few weeks, separate control strategies are not automatically restored. 

If a patient bends over to pick up a pencil, he or she should not require as much muscle recruitment as when lifting a heavy box; however, the patient still needs coordinated, sequential muscle function.  After an injury, the brain appears to lose the ability to differentiate between high and low-loading strategies.   Full HTML article: Failed Motor Programming and the Lumbar Multifidus in Locomotor System Dysfunction

This dysfunctional strategy results in a poorly stabilized spine.  The deep stabilizing muscles are no longer recruited to stabilize the lower back prior to arm, limb, or torso movement.  Instead, these muscles contract after limb movement occurs or not at all.  Therefore, our "first defense" against stress and strain is lost.

Normal Recruitment of Inner Unit		Dysfunction After Low Back Injury
Separate strategy for control by brain		Failure of separate strategy for control by brain, instead there is a global response
Anticipatory activation and early recruitment		Delayed recruitment for activation
Tonic activity with trunk movement or loading		Phasic activity with trunk movement or loading
Independent of force direction		Dependent of force direction
Independent co-activation of all inner unit muscles		Loss of co-activation of all inner unit muscles
Ability to perform a gradually developing isometric contraction		Inability to perform a gradually developing isometric contraction

A variety of outer unit muscles may become over-active to compensate for the impairment of the inner unit muscles.  This will be unique to the individual and therefore this needs to be assessed prior to prescribing specific back exercises. 

Over-activity of the outer unit is described by physicians or physical therapists as muscle spasm, which at greater intensities produces co-contraction rigidity even during low-level activities. 
 

WARNING!
 The Following Treatments Fail To Reduce Recurrence...

After lower back injury, the brain develops a dysfunctional, movement-coordination programming strategy with impaired deep stabilizing muscles and over-active, superficial, strength muscles.  This is the cause of the high rate of lower back pain recurrence.  This is based on science, not anecdotal evidence.  So what you need to understand is that...  

------------- Important Fact #6 -------------
A landmark study by the Australian professors showed that following a first episode of acute low back pain, people who do not perform specific exercises for the deep stabilizing muscles of the back and abdominal wall (without unwanted activation of superficial strength muscles) are 12.4 times more likely to have recurrence of back pain within 3 years.  7 out of ten participants who went through a 4-week program of retraining these deep stabilizing muscles to re-establish the brain's separate strategies of movement-coordination programming... reported three years later that their lower back pain had not returned.  Other studies show that these specific back exercises are also beneficial for those suffering from chronic lower back pain.
 Abstract: Long-term effects of specific stabilizing exercises for first-episode low back pain. 
 Abstract: Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis..)
 Abstract: Motor control problems in patients with spinal pain: a new direction for therapeutic exercise.
 Abstract: The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain.
 Abstract: Evaluation of specific stabilizing exercise in the treatment of low back pain and lumbar disk disease in outpatient rehabilitation.)
 Abstract: Muscle control-pain control. What exercises would you prescribe?
 Abstract: Altered abdominal muscle recruitment in patients with chronic back pain following a specific exercise intervention.
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Last update:
 Saturday April 21, 2007